The Eugene O’Neill Autopsy Project

I was always drawn to the politically brave, psychological power of O’Neill’s plays. I knew that he had suffered from a rather mysterious and ultimately lethal neurodegenerative disease. I was aware that he relocated to the Boston area in 1948 to be near his medical community as the disease progressed, that he lived at the Sheraton Hotel in Kenmore Square (now Shelton Hall, a Boston University dormitory), until his death in 1953, and that an autopsy was performed at Massachusetts General Hospital. Little did I know that Dr. E.P. Richardson, my guide and co-author of the 2000 New England Journal of Medicine article, was present at the autopsy! Or that, 40 years later, he would be able to retrieve the slides of Eugene O’Neill’s brain!

FIG. 4—Distribution of the Cerebellar Cortical Lesions in the Brain of Eugene O’Neill.
The first image shows axial sections of the cerebellar surface; the second sagittal sections
of the cerebellar hemisphere in the plane of the flocculus. Dark blue areas indicate marked
narrowing of the molecular layer, severe loss of Purkinje cells, and normal granule cells;
and the purple areas, moderate loss of Purkinje cells only.

The project fit my academic mission extremely well, emphasizing a multidisciplinary, integrative approach to human behavior.2 Dr. Richardson had served as a psychiatrist during WWII. He was inspired by his mentor, Dr. Stanley Cobb, who had also studied neurology, psychiatry, and neuropathology, combining them into a unique understanding of the brain. And, in my opinion, “EP” as he was known by many of his colleagues, was the “Eugene O’Neill of Neuropathology” given his profound, eloquent, and passionate contributions to our scientific understanding of the human condition.

As usual, the discovery process undulated with highs and lows. Dr. Richardson immediately embraced the project, marking it with his contagious grace, good cheer, enthusiasm, curiosity, and generosity of time. As part of the exploratory phase, my wife and I attended two plays with Dr. Richardson and his wife, Desire Under the Elms (1924) and Long Day’s Journey Into Night (1941). I remember looking at O’Neill’s brain with Dr. Richardson and two of my neurology and psychiatry residents using a multi-headed microscope. It was a rather surreal, reverential moment, involving that ever elusive quest to observe and capture genius by viewing brain anatomy. The biggest challenge was securing permission to publish our findings from O’Neill’s survivors. This took several daunting years, and included approaching the descendants of O’Neill’s daughter, Oona, whom he never spoke to after she married Charlie Chaplin when she was 18 and he was 54. During this hiatus, the manuscript languished in my files. Academic medicine, similar to the world of art, is often driven by passion alone and involves resilience, dogged pursuit, changing circumstances, midnight oil, and, ultimately, if you are lucky, reward. Our project had an enthusiastic beginning, was filed away for several years due to unforeseen reasons, jump started back to life, sputtered again, then was resurrected by the family’s permission and finally published! It also unexpectedly propelled us into the shadows of previously unknown worlds in this case theatre and O’Neill’s biographers.3

Dr. Richardson died on November 30, 1998. The article was published on April 13, 2000. Since then, over 30 mutations of late-onset spinal cerebellar atrophy have been identified. Dr. Richardson would be so thrilled by such progress! This project, a five year journey in patience and fortitude with Dr. Richardson, proved to be one of the most rewarding experiences of my career. It made me a better physician, teacher, and mentor. I clearly had the good fortune of being at the right place, at the right time, and with the right mentor.